Revised as of January 2015

Per CSC Resolution No.

1500088
Promulgated on January 23,
2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

As of DECEMBER 2018
(Required by R.A. 6713)

Note: Husband and wife who are both public officials and employees may file the required statements jointly or separately.
 Joint Filing  Separate Filing  Not Applicable

DECLARANT: PACIOSANE CRISTINE A. POSITION: TEACHER - I

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED- MASBATE PROVINCE
ADDRESS: SALVACION BALUD MASBATE OFFICE ADDRESS: RODEO RD. MASBATE CITY

SPOUSE: NONE NONE NONE POSITION: NONE

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S

HOUSEHOLD

NAME DATE OF BIRTH AGE

NONE NONE NONE

ASSETS, LIABILITIES AND NETWORTH

(Including those of the spouse and unmarried children below eighteen (18)
years of age living in declarant’s household)
1. ASSETS
a. Real Properties*

DESCRIPTION KIND EXACT ASSESSED CURRENT FAIR ACQUISITION ACQUISITION

(e.g. lot, house and (e.g. residential, LOCATION VALUE MARKET VALUE COST
lot, condominium commercial, industrial,
and improvements) agricultural and mixed (As found in the Tax Declaration of
use) Real Property) YEAR MODE

NONE NONE NONE NONE NONE NON NONE NONE

E

Subtotal:
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

CELLPHONE 2016 17,800.00

LAPTOP 2016 7,500.00
PRINTER 2016 2,700.00

Subtotal : 28,000.00
28,000.00
TOTAL ASSETS (a+b):
* Additional sheet/s may be used, if necessary.
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY LOAN EASTWEST RURAL BANK 100,000.00

EMERGENCY LOAN/CONSO-LOAN GSIS 59, 000.00
SALARY LOAN SAN JACINTO 190, 000.00

TOTAL LIABILITIES: 349,000.00

NET WORTH : Total Assets less Total Liabilities = 321, 000.00
* Additional sheet/s may be used, if necessary.

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

(of Declarant /Declarant’s spouse/ Unmarried Children Below Eighteen (18) years of Age Living in Declarant’s Household)
 I/We do not have any business interest or financial connection.

NAME OF BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF

ENTITY/BUSINESS INTEREST &/OR FINANCIAL INTEREST OR
ENTERPRISE CONNECTION CONNECTION
NONE NONE NONE NONE

RELATIVES IN THE GOVERNMENT SERVICE

(Within the Fourth Degree of Consanguinity or Affinity. Include also Bilas, Balae and Inso)
 I/We do not know of any relative/s in the government service)
NAME OF RELATIVE RELATIONSHIP POSITION NAME OF AGENCY/OFFICE AND ADDRESS
LEMAR B. PACIOSANE COUSIN T-I DEPED-MASBATE PROVINCE

I hereby certify that these are true and correct statements of my assets, liabilities, net worth,
business interests and financial connections, including those of my spouse and unmarried children
below eighteen (18) years of age living in my household, and that to the best of my knowledge, the above-
enumerated are names of my relatives in the government within the fourth civil degree of consanguinity
or affinity.

I hereby authorize the Ombudsman or his/her duly authorized representative to obtain and
secure from all appropriate government agencies, including the Bureau of Internal Revenue such
documents that may show my assets, liabilities, net worth, business interests and financial
connections, to include those of my spouse and unmarried children below 18 years of age living with
me in my household covering previous years to include the year I first assumed office in government.

Date: January 23, 2019

CRISTINE A. PACIOSANE
(Signature of Declarant) (Signature of Co-Declarant/Spouse)

Government Issued ID: PRC LICENSE Government Issued ID:

ID No.: 1317571 ID No.:
Date Issued: 11-12-2014 Date Issued:

SUBSCRIBED AND SWORN to before me this 24TH day of JANUARY , affiant exhibiting to
me the above-stated government issued identification card.

_______________________________________
(Person Administering Oath)